The Confusion Behind Screening Mammograms
Dr. Veena Chandrakar is an oncologist who practices in Cypress, Texas. Dr. Chandrakar specializes in breast cancer, colorectal cancer, lung cancer, and lymphomas as well as all other malignancies and hematological conditions.
Mammograms are an essential part of screening for breast cancer. With early detection, breast cancer can be found at earlier stages of the disease process leading to an appropriate multidisciplinary treatment approach and potential cure. So, when do you start screening for breast cancer? This question has a lot of confusing answers.
Why is it important to do annual mammograms?
Breast cancer is the most frequent cause of non-skin cancer and cause of death worldwide. It's the second most frequent cause of death in the United States in women. Early detection helps to decrease the odds of dying from breast cancer and facilitates early treatment.
How often are breast cancers diagnosed?
The majority of breast cancers are diagnosed as a result of an abnormal screening mammogram. In the United States, breast cancers account for over 260,000 cases each year and are responsible for over 40,000 deaths.
Why are there so many different recommendations of when to start and when to stop doing mammograms?
The reason behind this is that there are several different organizations that have created screening guidelines. Most of the organizations have clinicians who may be part of your care such as primary care physicians, gynecologists, medical oncologists, and breast surgeons.
The societies that have created guidelines for breast cancer screening are the following: the American Cancer Society, the U.S. Preventative Services Task Force, the American College of Obstetrics and Gynecology, and the American Society of Breast Surgeons.
The guidelines differ in their recommendations slightly.
What are the guidelines for each organization?
American Cancer Society in an average risk patient (less than 15% lifetime risk of developing breast cancer):
Ages 40 to 44: Have the option to start screening with a mammogram every year
Ages 45 to 54: Should get mammograms every year
Ages 55 and older: Can switch to every other year OR choose to continue yearly mammograms
Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. ACS does not recommend regular clinical breast exams or breast self-exam in the average risk patients who do not have any breast issues. However, all women should be familiar with how their breasts look normally and feel and report any change to their health care provider right away
Despite these recommendations by the American Cancer Society, the World Health Organization does feel that women should still do self-breast exams to be familiar with any abnormalities.
Guidelines from the U.S Preventive Service Task Force:
There are no requirements for routine screening mammography in women aged 40 to 49 years. Biennial screening mammography (every 2 years) is recommended for women between the ages of 50 and 74 years.
The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account the patient context, including the patient's values regarding specific benefits and harms.
Guidelines from the American College of Obstetrics and Gynecology
Breast self-awareness should be encouraged and can include breast self-examination; women should report any changes in their breasts to their health care providers.
For women aged 20–39 years, clinical breast examinations are recommended every 1–3 years.
For women aged 40 years and older, clinical breast examination should be performed annually.
For women aged 40 years and older, they should be offered screening mammography annually.
Women should be educated on the predictive value of screening mammography and the potential for false-positive results and false-negative results; women should be informed of the potential for additional imaging or biopsies that may be recommended based on screening results
Biennial screening may be a more appropriate or acceptable strategy to some women and recommends the screening strategy should therefore be determined based on the patient's individual risk and values.
Guidelines from the American Society of Breast Surgeons
Women age >25 should undergo formal risk assessment for breast cancer.
Women with an average risk of breast cancer should initiate yearly screening.
Mammography at age 40.
Screening mammography should cease when life expectancy is <10 years.
Women with a higher-than-average risk of breast cancer should undergo yearly screening mammography and be offered yearly supplemental imaging; this screening should be initiated at a risk-based age.
The differences in the variety of recommendations can certainly be confusing. However, all the different societies do agree that there are clear benefits of screening for breast cancer.
The decision of when to perform mammography should be determined with shared decision-making in which your clinician helps you make an informed decision about when to start screening and stop screening. The above explanation of the guidelines can be used to discuss with your provider your preferences.
